What is embolization? What is its purpose?

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An embolization is a procedure that involves occluding arteries supplying the arteriovenous malformation, in order to eliminate or reduce communications between arteries and veins.
By reducing the blood supply, the aim is to reduce the volume of the malformation, thereby limiting symptoms and the risk of complications.
Embolization is sometimes performed prior to surgery to reduce intraoperative blood loss.
In an emergency, embolization can be performed to stop acute bleeding.

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How do you prepare for this type of operation?

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The procedure is usually performed under general anaesthetic, sometimes under conscious sedation; it is therefore essential to have an anaesthetic consultation within 3 months of the procedure (no less than 48 hours before the procedure).
A blood test will be taken, including a coagulation and platelet count study.
In most cases, you will be hospitalized the day before and must fast from midnight onwards (no drinking, eating or smoking). On the morning of the procedure:
- You will be groomed with an aseptic shower
- You will be taken to the operating room approximately 30 minutes before your procedure, in accordance with the
operating room schedule.
- You will be taken care of by the anesthesia team and radiology manipulators, and an infusion
will be set up in the operating room.

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How does the procedure work?

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After general anesthesia or sedation, you will be taken care of by the interventional radiologist.

The procedure involves pricking an artery (usually the femoral artery) and positioning a tube called a "catheter" in the abnormal vessels of the arteriovenous malformation. Through this catheter, a global assessment of the malformation is made by injecting contrast medium. Then, through the same catheter, the vessel is occluded.
Arterial occlusion can be achieved using a variety of products (such as biological glue, micro-particles, alcohol or other sclerosing agents), chosen by the operator according to the characteristics of the malformation.
It is also possible to use materials such as coils, small filaments of inert metal, to occlude the arteries.

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What happens after the operation?

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After the operation, you will be taken to the recovery room and monitored by the anesthesia team for 2-3
hours. You will then be taken back to your room in the hospital ward.
The hospital stay generally lasts 24-48 hours, to ensure that there is no pain or complication.
Sometimes, the after-effects may be marked by moderate pain and an increase in the volume of the
malformation, which then appears firmer and discreetly inflamed. Treatment with painkillers
and/or anti-inflammatories is then prescribed for a few days. These signs disappear after several
days or weeks.
The effectiveness of the procedure will be assessed after 3 months.

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What are the risks of embolization?

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This treatment has proven its effectiveness, but must be carried out in a specialized environment, and by a team accustomed to dealing with these malformations.
In rare cases, complications may occur:
- Minor, such as bleeding at the puncture site
- Major in the form of accidental occlusion of a normal vessel by a blood clot or by the embolization material. The consequences of this occlusion depend on the nature of the artery and the territory it irrigates.
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In addition, neuroradiology examinations use X-ray equipment that emits X-rays. X-ray doses vary according to the duration of the procedure, its complexity and your build. For particularly long examinations, skin lesions may appear. These lesions are essentially redness similar to sunburn, or transient hair loss.
In such cases, we recommend that you contact the neuroradiology department, which will take the appropriate follow-up measures.

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What precautions should be taken after surgery?

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It is advisable to rest for 2 to 3 days after discharge from hospital. This often means taking time off work. Resumption of school or professional activities is essentially guided by the intensity of
residual pain.
The same applies to resumption of sport, while avoiding any direct impact during the first 15 days, which could accentuate the pain.
An analgesic and/or anti-inflammatory treatment will be systematically prescribed and adapted according to the intensity of the pain. This treatment should usually not exceed 5 to 7 days. There are no medical contraindications.
You will be seen again in consultation 3 months after the procedure, to assess its effectiveness.

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What is the follow-up after embolization?
A clinical and radiological check-up (ultrasound or MRI) will be carried out 3 months after the embolization procedure, to assess the effectiveness of the treatment.

If the procedure is insufficiently effective, it can be repeated to complete the occlusion, under the same conditions.
In the event of repeated failure, the use of another strategy should be discussed with the care team during a multidisciplinary consultation.

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